title: Precipitous exit block with epicardial steroid-eluting leads.
abstract: Between January 1990 and October 1992, we implanted 16 steroid-eluting ventricular epicardial pacing leads (Medtronic 10295A and 10295B/4965) in 12 patients. There were 8 males and 4 females ranging in age from 3 months to 49 years (mean 8.7 +/- 13.2, median 6.0 years). Structural cardiac disease was present in 11 of 12 patients. Follow-up ranged from 3-73 months postimplant (mean 35.7 +/- 22.3, median 28.5 months). Lead fracture (10295A) occurred in 1 of 12 patients. Of the remaining 11 patients, 8 of 11 have very low long-term pacing thresholds. Unexpectedly, 3 patients demonstrated precipitous threshold increases from 3 months to 3.5 years postimplant. Although no deaths resulted in these exit block patients, 1 of 3 exit block patients developed marked worsening of congestive heart failure. We reviewed and analyzed the data obtained at 4 weeks postimplant for all of the 10295A and 4965 patients in the entire Medtronic clinical study database. Using the criterion of a 4 week postimplant pacing threshold > or = 0.12 ms (5 V), we found that the long-term risk of eventual exit block was 27.3% for the 10295A lead (P = 0.005) and 7.5% for the 10295B/4965 lead (P = 0.03). We, therefore, recommend that in patients implanted with the 4965 steroid-eluting epicardial lead, ventricular pacing thresholds > or = 0.12 ms (5 V) measured at 4 weeks postimplant should prompt frequent threshold testing to detect late and potentially sudden ventricular pacing threshold increases.
authors.affiliation: Georgetown University Medical Center, Washington, D.C., USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Beder
authors.forename: K S
authors.initials: KS
authors.lastname: Kuehl
authors.forename: R A
authors.initials: RA
authors.lastname: Hopkins
authors.forename: L M
authors.initials: LM
authors.lastname: Tonder
authors.forename: D R
authors.initials: DR
authors.lastname: Mans
mesh_terms: D000293:Adolescent; D000328:Adult; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006327:Heart Block / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000187:drug effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000628:therapy; D017211:Treatment Failure
chemical_list: D005938:Glucocorticoids